Recurrent Croup

Croup in Children and Risk Factors

Croup is a common respiratory illness in children under 5 years, primarily caused by viral infections. Symptoms include inspiratory stridor, barking cough, and hoarseness due to inflamed vocal cords. Diagnosis is based on symptoms difficulty breathing, stridor, chest in-drawing voice changes and head nodding. Severity ranges from mild to severe cases. This study aimed to explore variations in croup and factors contributing to its recurrence in children. This retrospective longitudinal study analyzed health records from the Pediatric Practice "Vitalino" in Veles, North Macedonia, from 2016 to 2022. It included children aged 0-5 years who had croup at least once. The sample was substantial and representative, allowing for a thorough examination of potential correlations and trends in croup occurrence. Among 707 studied children, 254 had croup, with a prevalence of 35.9% over seven years or 5.1% per year. Females had lower odds of recurrent croup, while males had higher odds, but the differences were not statistically significant. Atopic dermatitis and bronchiolitis exposure were significantly associated with croup in both genders. The study provides insights into the prevalence, distribution of croup and associated conditions in young children. The significant associations of atopic dermatitis and bronchiolitis suggest a link between these conditions and recurrent croup. Considering these strong associations, we can conclude that bronchiolitis and croup should be included in the trajectory of the atopic march.

Critical Stenosis Because of Vocal Cord Synechiae in a Child

Stridor is a clinical sign of an underlying disease and a common reason for pediatric emergency department (PED) consultation. Patients presenting with stridor must be evaluated to determine the origin of this abnormality. We present the case of a 7-year-old female patient who presented to our Pediatric Emergency Department with a history of recurrent episodes of stridor with increasing frequency over the previous 4 years, for this reason she was previously admitted to the pediatric intensive care unit. Findings from the otorhinolaryngologic assessment with flexible fiber-optic endoscopy led to a diagnosis of congenital synechia of the vocal cords. The cervical CT scan evidenced critical stenosis of the airway. An initial cordectomy and placement of a silicone device for fixation were performed. Subsequently, the patient required 6 additional interventions for progressive dilation of the glottic space at the level of the vocal cords and injections of mitomycin C injections (an antineoplastic that inhibits collagen proliferation). This case highlights the importance of additional studies (especially examination of the upper airway) when atypical or recurrent findings are revealed by the clinical history, physical examination, or disease course in patients with croup to prioritize cases severe enough to require pediatric intensive care unit admission.

Infantile Fibrosarcoma With Concurrent Infantile Hemangioma: A Case Report

This report focuses on the clinical course and treatment of an infant male who had a progressively enlarging tongue mass initially thought to be an infantile hemangioma but was later found to be an infantile fibrosarcoma. Treatment included surgical excision with anticipated difficult mask ventilation with active rhino/enterovirus infection bronchiolitis and recent croup. Complete surgical excision is the mainstay of treatment, and the patient did have negative margins after complete surgical re-excision. The patient has surveillance MRI scans and remains without fibrosarcoma recurrence. This case report highlights complex pediatric airway management and the need for vigilance in healthcare when common presentations, such as infantile hemangioma, also present with a concurrent rare disease at a different anatomic location, such as infantile fibrosarcoma in this case.